title: Vasoplegia in septic shock: do we really fight the right enemy?
abstract: Vasoplegia is a key factor for the death of patients with septic shock in intensive care unit owing to persistent and irreversible hypotension. Impairment of vascular reactivity has been attributed to a combination of endothelial injury, arginine-vasopressin system dysfunction, release of other vasodilatory inflammatory mediators, and muscle hyperpolarizaton. Nitric oxide induced by a Ca(+2) independent isoform of nitric oxide synthase has been suggested to play an important role in sepsis-induced vasoplegia. However, inhibition of nitric oxide synthase only partially restores the endotoxin-induced vascular hyporeactivity. The aim of this review is to discuss in detail the recent suggested alternative mechanisms of vasoplegia and to briefly outline the current therapeutic strategies and the novel therapeutic options based on those mechanisms.
authors.affiliation: Department of Anaesthesia, Dalhousie University, Halifax, Nova Scotia, Canada B3H 2Y9. Electronic address: n_sharawy@yahoo.com.
authors.forename: Nivin
authors.initials: N
authors.lastname: Sharawy
mesh_terms: D001685:Biological Factors / Q000378:metabolism; D003422:Critical Care; D006801:Humans; D006861:Hydrogen Peroxide / Q000378:metabolism; D009569:Nitric Oxide / Q000096:biosynthesis; D019001:Nitric Oxide Synthase / Q000378:metabolism; D017382:Reactive Oxygen Species / Q000378:metabolism; D012772:Shock, Septic / Q000150:complications*; D056987:Vasoplegia / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*
chemical_list: D001685:Biological Factors; D017382:Reactive Oxygen Species; C067410:endothelium-dependent hyperpolarization factor; D009569:Nitric Oxide; D006861:Hydrogen Peroxide; D019001:Nitric Oxide Synthase
keywords: H(2)O(2); Sepsis; Shock; Vasoplegia